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Was born in Cirebon, Jawa BaratMedical Doctor (MD), UNIVERSITAS INDONESIAMaster of Public Health (MPH), HARVARD-USADoctor of Science (ScD): JOHNS HOPKINS-USAPost Doctoral in Statistics: UNIV of MICHIGAN-USACurrent Activities:
Indonesian Public Health Assoc, PresidentDept of Health Policy & Administration, UI, ChairNational Team for Poverty Reduction Acceleration, Vice
President Office (TNP2K), Human Resource SpecialistExpert Committee on TB - MoH, Health Policy SpecialistMoH National NCD Roadmap, Lead ConsultantCountry Coordination & Facilitation (CCF Indonesia) for
HRH, Menko Kesra Office, Head of SecretariatCtr for Health Admin & Policy Studies(CHAMPS-UI), DirectorTeaching and advising PhD students, Medical, Dentistry,
Public Health, Nursing schools of several universities
Adang Bachtiar
INTER-PROFESSIONAL EDUCATION
A Public Health Education’s Point Of View
Adang Bachtiar [email protected]
Bali – Desember 2011
THE GLOBAL PUBLIC HEALTH CHALLENGES
49%
27%
9%
15%
22% 43%
14%
21%
Communicable diseases, maternal and perinatalconditions andnutritional deficiencies
NCD
Neuropsychiatric Disorders
Injuries
1990 2020
Source: WHO, Evidence, Information and Policy, 2000
YR 2000 PREDICTION
YR 2008 (NEW) PREDICTION
2005: 60% deaths, related to NCD
(from 27%: 1990) 47% global burden
2020 (prediction): 73% deaths, related to NCD (Yr
2000 prediction: 43%) 60% global burden
80% NCD problems at LMIC (related to poverty)
WHO (2008)
POVERTY
Decrease in:•Quality of life•Productivity•Learning ability•Savings
Increase in:.Debts.Dependency
NCDIncrease in: •Personal & env risks•Unbalanced diet
Decrease in:•Education & information access•Ability to access services
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting, (Doha, Qatar, May 2009)
Global Risk Assessment 2009World Economic Forum
Asset price collapseRetrenchment from globalization
Oil and gas price spike
NCDs
Flu pandemicFiscal crisis
Food crisis
Infectious disease
LIKELIHOOD
SEVE
RIT
Y IN
US$
NOT ONLY Commonality factors…
Tobacco
Diet
Physical Activity
Alcohol
Cardiovascular
Cancers
Diabetes
Chronic Respiratory
Osteoporosis
Oral Health
Mental Health
Source: WHO, Global Status Report on NCD, 2010
BUT..FAST GROWING FUNDAMENTAL ROOT CAUSES
UNBALANCED DIET SEDENTARY LIFE STYLE
% Lipids
¯ SERATvegetablescereal
Phytoestrogensbioactivate molecules
¯ Folate, B6 ®
Homocysteinaemia ® Thrombosis
OBESITY ® DIABETES ® CHDSex hormone
changes
CANCERS: breast, endometrium
Trans fatty acids
Saturated fats
+ + +
+ +
+
-
-
Antioxidants
+
-
+
+
+
+
Total Fat
n-3 fatty acids -Atherosclerosis
BEYOND HEALTH DETERMINANTS (!)
Modified from: WHO, Global Status Report on NCD, 2010
SOLUTION?
3-“Health in All Policy”
2-Health System Level
3 LEVEL STRATEGIES
5 MDG Targets
MDG-NCDTargets
1-Family & Community
Level
Primary care
Referral care
Social Capital
for health
6.Health leadership
5.Financing h-care
4.Drugs & supplies
3.Surveillence
2.Manpower mgmt
1.Quality of care
Public Health services Food securityHealth sector Policies
Community Based
Poverty reduction
acceleration
Gender
TNP2K
Family welfare
Education
4 NCD Risks
Food Safety
Taxes
Trades
PUBLIC HEALTH CARE
SYSTEM
• Central & sub-national regulations• Sectoral synergism
• Resource mobilisation
• PROMOTIVE• PREVENTIVE• CURATIVE• REHABILITATIVE• DEVELOPMENT• Infrastructure• Human resource• Budget• Quality Assurance• Participative
•Effective monitoring system
•Empowerment
•Self reliance
Professionalism Multidisciplinary Life Long Learning
PARTICIPATIVE & EMPOWERED
EFFECTIVITY
PUBLIC HEALTH POLITICS & POLICY
DemandSupply
Advocacy
GOAL:Accessibility-Availability-Quality-Equity
What is Inter-Professional
Education?
Grouped students in multidisciplinary teams Assigned teams a problem from “practices” Guided students through the steps of the
problem-solving process Recognize relevant knowledge Identify what needs to be learned Acquire knowledge and work towards
solution
CORE ELEMENTSFACILITATOR
TASKSISSUES
PROBLEMS(CONTAINING SOME
UNKNOWN ELEMENTS)
STUDENT GROUPTHE LEARNING ‘”FIELD”
KICK-STARTS LEARNING PROCESS
GROUP DYNAMICS
GROUP RESPONSE
5 PROPOSED DOMAINS
.
.
.1.GOAL:
Participatory, collaborative and
coordinated partnership between multi-providers
and clients
3.DEALING WITH INTER-PROFESSION
AL DIFFERENCES & FOCUS
4.COLLABORATIVE LEADERSH
IP
5. COMMUNIC
ATION & TEAM
FUNCTIONING
2.ROLE CLARIFICA
TION & DEVELOPM
ENT
SIMPLE
COMPLEX
Q-
AU
DI
T
TQ
M-
RIS
K
MG
MT
CLA
SS
– L
AB
-
CLIN
ICA
L/R
EFER
RA
L -
P
HC
Modified from: Canadian Interprofessional Health Collaborative, 2010
CLIENT CENTERED Competency Statement:
Learners/practitioners seek out, integrate, and value, as a partner, the input, and the empowerment of patient/client/family/ community in designing and implementing public health care
SIPOC paradigm:
I P O CS
I P O CS
Internal:
External:
Domain -1:
ROLE CLARIFICATION
Competency Statement: Learners/practitioners understand their own
role and the roles of those in other professions, and use this knowledge appropriately to establish and meet patient/ client/family and community public health goals.
Domain -2:
DEALING WITH INTER-PROFESSIONAL DIFFERENCES AND FOCUSES
Competency Statement: Learners/practitioners actively engage self
and others, including the client/patient/ family and community, in positively and constructively addressing interprofessional conflict as it arises.
Domain -3:
COLLABORATIVE LEADERSHIP
Competency Statement: Learners/practitioners understand and can
apply leadership principles that support a collaborative practice model.
Domain -4:
COMMUNICATION &TEAM FUNCTIONING
Competency Statement: Learners/practitioners understand the
principles of team dynamics and group processes to enable effective interprofessional responsive communication and team collaboration.
Domain -5:
CONTEXTUALITIES
3 concepts underpinning the 5 domains:
THE CONTEXT OF PRACTICES
ENCOUNTERED COMPLEXITY
QUALITY AND SAFETY PARADIGM
PRACTICES CONTEXT
According to the nature of Public Health, practice options can be at: Class:
E.g., simulation of cases from different angles and profession
Laboratory: E.g., genome aspect of public health
Clinical settings: E.g., case management and risk
identification-mgmt Community and social settings:
E.g., full public health intervention
ENCOUNTERED COMPLEXITY_1
Community-based health effort Interprofessional education related to:
Community mobilisation & health promoteur
Family health care, including Family physician, Community nurses & Midwives
Env health assesor and epidemiologist Health administrator at PHC level Public health disaster team
ENCOUNTERED COMPLEXITY_2
Primary care IPE related to:
Health planner & administrator at PHC level Health promotion specialist Family health care, including Family
physician, Community nurses & Midwives Epidemiologist & Env health manager Primary medical & public health disaster
team
ENCOUNTERED COMPLEXITY_3
Referral care IPE related to:
Hospital manager Health promoteur and counsellor Hospital epidemiologist Health and safety specialist Medical doctors Nurses and midwives Other health profession at hospital
QUALITY & SAFETY ASPECT
The spectrum can be, respectively: Quality inspection Quality audit and review Quality assurance Total Quality Improvement including patient
safety Risk management at public health settings
Rubric to Evaluate IPE
Descriptors
Criteria 3 2 1
Descriptors
Criteria 3 2 1
Realism Based on an actual or fictionalized real-world situation linking topic to learner.
Contrived or contains unrealistic elements that decrease credibility.
Unrealistic, lacking relevant context.
Rubric to Evaluate IPE
Descriptors
Criteria 3 2 1Realism Based on an actual or
fictionalized real-world situation linking topic to learner.
Contrived or contains unrealistic elements that decrease credibility.
Unrealistic, lacking relevant context.
Content Addresses significant conceptual issues; directly related to major content goals.
Encourages superficial rather than in-depth understanding concepts.
Relevance of topic peripheral or not apparent.
Rubric to Evaluate IPE
Descriptors
Criteria 3 2 1Realism Based on an actual or fictionalized
real-world situation linking topic to learner.
Contrived or contains unrealistic elements that decrease credibility.
Unrealistic, lacking relevant context.
Content Addresses significant conceptual issues; directly related to major content goals.
Encourages superficial rather than in-depth understanding concepts.
Relevance of topic peripheral or not apparent.
Engage-ment
Stimulates discussion and inquiry through its relevance and presentation.
Generates limited or superficial discussion; provokes little curiosity.
Lacks a “hook”; obscure or pedantic presentation.
Rubric to Evaluate IPE
Descriptors
Criteria 3 2 1Complexity Appropriately
challenging; group effort and cooperation required; some ambiguity appropriate; integrates multiple concepts.
Difficult but may encourage a “divide and conquer” approach. Concepts not well integrated.
Solution accessible to most students working alone; focused on single concept.
Rubric to Evaluate IPE
Descriptors
Criteria 3 2 1Complexity Appropriately challenging; group effort
and cooperation required; some ambiguity appropriate; integrates multiple concepts.
Difficult but may encourage a “divide and conquer” approach. Concepts not well integrated.
Solution accessible to most students working alone; focused on single concept.
Resolution Open to multi-disciplinary resolutions or multiple pathways to solution, depending on students assumptions and reasoned arguments.
Resolution is more obvious but allows reasonable opportunity for judgment and discussion.
One right answer is expected; limited opportunity for analysis and decision making.
Rubric to Evaluate IPE
Descriptors
Criteria 3 2 1Structure Progressive
disclosure via multiple stages, multi angle builds on existing students knowledge.
Staging does not flow well; transition could be improved.
Too much or too little information provided at once; short cuts thinking/research.
Rubric to Evaluate IPE
Descriptors
Criteria 3 2 1Structure Progressive disclosure via
multiple stages, builds on existing student knowledge.
Staging does not flow well; transition could be improved.
Too much or too little information provided at once; short cuts thinking/research.
Questions Analytic in number, short, and open-ended; encourage deeper understanding.
Most are directive & descriptive; preempt student-generated learning issues.
Lead to “yes-no” answers rather than thoughtful discussion.
Rubric to Evaluate IPE
Descriptors
Criteria 3 2 1Structure Progressive disclosure via multiple
stages, builds on existing student knowledge.
Staging does not flow well; transition could be improved.
Too much or too little information provided at once; short cuts thinking/research.
Questions Limited in number, short, and open-ended; encourage deeper understanding.
Most are directive; preempt student-generated learning issues.
Lead to “yes-no” answers rather than thoughtful discussion.
Research Promotes substantive research using multiple approaches.
Research limited to secondary data and textbook material.
Limited necessity for research.
Rubric to Evaluate IPE
WAY FORWARD
1. Organisation of physical resources
2. Organisation of IPE teaching team
3. Syllabus content
4. Managing student groups
5. Evidence of benefits required
6. The risks involved
7. Where next?